Pediatric Therapeutic Services

How Multi-Tiered Systems of Support Transform Your Program and Budget

As a special education administrator, you walk a fine line between the perils of saying “yes” to everyone requesting related services for a student, and the potential consequences of saying “no.”

What if there was a way to help more students, including many who’d otherwise go unhelped, while reducing unnecessary referrals and controlling costs?

A Multi-Tiered Systems of Support model can make it happen.

At Pediatric Therapeutic Services (PTS), we see concerned teachers flooding our clinicians with requests to screen students who appear to have never held a pencil, or who seem completely incapable of staying seated at a desk.

When our therapists observe many of these students, they do see genuine functional issues. But who has time to treat 30% of a school’s kindergarteners? 

The administrators who partner with us trust us to make sure no students who need services slip through the cracks—a legal liability—while also getting escalating therapy expenses under control. Not an easy task!

However, applying an MTSS model to related services  can rein in both caseloads and costs without sacrificing positive student outcomes. In fact, it can even create more of them, and we’ve got the data to prove it.

Why MTSS in Education Isn’t Just for Academic Subjects

When people think about Multi-Tiered Systems of Support (MTSS), they generally think about tracking students’ responses to interventions and supplemental instruction in subjects like reading and math, then using that data to determine eligibility for various levels of service. 

But what would happen if ALL students got some foundational Tier 1 supports in the general education classroom, and a few who struggled were able to receive some supplemental Tier 2 services?

To answer that question, consider an MTSS model success story from one of our larger client school districts.

Five years ago, this district was experiencing an ever-increasing wave of Occupational Therapy (OT) referrals. All kinds of student needs drove it, from handwriting to sensory processing.

When our therapy team screened students, a large number of them had significant functional issues in the classroom. Many came up “hot” on normed testing protocols, leaving teams little choice but to qualify them for ongoing services.

We suggested implementing an MTSS approach, and found the administration solidly on board.

This program was different from others in that we used a “triage” approach to screens and interventions. We had permission to deliver direct services for up to one year under Tier 3 RtII (Response to Instruction and Intervention). 

We delivered most of that direct service to students in small groups. We collected data and monitored their progress throughout the treatment period.

While many students in Tier 3 became part of a multidisciplinary evaluation and ultimately received services on an IEP (Individualized Education Program), the vast majority didn’t. These students made progress with supplemental instruction and were ultimately discharged from services.

Fewer Required Screenings and Lower Costs Per Student

Unsurprisingly, during the first year we saw a big initial push for giving students direct service.  Buildings tried to bypass the process altogether (hence the drop in diagnostics in 2015-16). The therapy team and administration invested a lot in fine tuning eligibility criteria.

PTS delivered many hours of free teacher training in Tier 1 strategies. These strategies helped teachers address the most common reasons for OT referrals. We also formed handwriting and sensory Tier 2 groups in multiple buildings.

Eventually, the trends stabilized. Fewer students were ultimately determined to have an actual disability.

Over the past three years, this collaboration has consistently yielded a steady decline in required screenings and evaluations. As a result, the district has saved tens of thousands of dollars in diagnostic costs alone.

Line graph tracking related services screenings and evaluations from 2015-20, gradually declining in the last four years.

Line graph tracking district’s diagnostic costs from 2015-20, declining from $40 million to $25 million over the last four years.

Another interesting discovery: The cost of seeing students under Tier 3 RtII averaged 47% less than providing services on an IEP. Several reasons account for this saving:

  • Students were eligible to continue services without additional testing or qualification for special education for only a limited time.
  • Formal testing requirements, quarterly progress notes, and necessary meetings were reduced, resulting in a significantly lower paperwork burden.
  • Therapists generally saw students receiving Tier 3 services in groups focused on a specific skill area.  

We also discovered the average cost per student receiving services on an IEP dropped 19% over the four years.

We think the reason for this reduction is because an MTSS model empowers teachers. It gives them new tools and strategies for helping students. Investing in teacher training around Tier 1 interventions facilitated far greater carryover of therapeutic strategies into day-to-day classroom routines.  

Bar graph of average cost per student served in 2016-20, declining from about $1,800 to about $1,500 over the last three years.

PTS’ MTSS Model Can Help You Serve Students and Save Money

By using a Multi-Tiered Systems of Support framework in this district, we supported significantly more students while minimizing the impact on the related services budget. A “win-win” for everyone!

Moving to such a model takes a strong, collaborative relationship with your therapy provider.  Accurate referrals and costs data are key to avoiding some pitfalls of opening up direct services to more students. Yet as the data above reveal, the benefits are clear and the impact on cost control is positive.

To see similar results in your program, request your free Related Services Audit today. We’ll show you immediate opportunities for expanding your impact on students without expanding your expenses!

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